Putting It All Together: It's Your Choice
You can choose….
Breast cancer is very different than other medical diagnoses. If you break your leg, your doctor probably won’t ask you what type of surgery you want. If you are diagnosed with high blood pressure, your doctor probably won’t ask which blood pressure medicine you prefer. However, for stage I or II breast cancer, doctors often ask the patient for help in determining a treatment plan.
Patients with early-stage breast cancer are often faced with the following questions:
- Breast-conserving surgery or mastectomy?
- Reconstruction now or later?
- Chemotherapy or surgery first?
- Five days of more intense, localized radiation or 6 to 7 weeks of whole-breast radiation?
Having choices is considered a gift by many patients but a burden by some. These choices exist because choosing one option over another may not affect ultimate survival or even, in many cases, recurrence risk. You must make the best choice given the information available at the time. Ask your doctors lots of questions about risks, late effects, and the benefits of one option over another. If you are still uncertain what treatment will be best for you, ask to speak with other members of your treatment team (such as radiation oncology, medical oncology, plastic surgery). If you are not comfortable with your doctor or your treatment plan, seek a second opinion.
What Are the Surgical Choices in Breast Cancer Care?
Michele M. Carpenter, MD, FACS
Breast Program Director, The Center for Cancer Prevention and Treatment, St. Joseph Hospital, Orange, CA
Breast Conservation |
Mastectomy |
|
Pro |
Pro |
|
Survival equal to mastectomy |
Survival equal to breast conservation |
|
Shorter recovery |
Avoid potential return to OR for margins |
|
Improved body image |
Radiation likely avoided |
|
Minimize risk of surgical complications |
No imaging of mastectomy site required in the future |
|
May avoid axillary dissection for 1-3 positive nodes |
|
|
With modern treatment plans, local recurrence risk is same as mastectomy
|
|
|
Con |
Con |
|
Requires frequent imaging follow-up |
May require contralateral surgery for symmetry |
|
May have different reconstruction options in the event of a local recurrence |
Increased risk of surgical complications |
|
|
More likely to have an axillary dissection if nodal disease is identified |
Take time to make the best decision for yourself. Keep in mind that while family and friends may give you their opinions, in the end it is your choice.
